Distribution of hygiene kits during a cholera outbreak in Kasaï-Oriental, Democratic Republic of Congo: a process evaluation

Abstract

Background: Cholera remains a leading cause of infectious disease outbreaks globally, and a major public health threat in complex emergencies. Hygiene kits distributed to cholera case-households have previously shown an effect in reducing cholera incidence and are recommended by Médecins Sans Frontières (MSF) for distribution to admitted patients and accompanying household members upon admission to health care facilities (HCFs). Methods: This process evaluation documented the implementation, participant response and context of hygiene kit distribution by MSF during a 2018 cholera outbreak in Kasaï-Oriental, Democratic Republic of Congo (DRC). The study population comprised key informant interviews with seven MSF staff, 17 staff from other organisations and a random sample of 27 hygiene kit recipients. Structured observations were conducted of hygiene kit demonstrations and health promotion, and programme reports were analysed to triangulate data. Results and conclusions: Between Week (W) 28-48 of the 2018 cholera outbreak in Kasaï-Oriental, there were 667 suspected cholera cases with a 5% case fatality rate (CFR). Across seven HCFs supported by MSF, 196 patients were admitted with suspected cholera between W43-W47 and hygiene kit were provided to patients upon admission and health promotion at the HCF was conducted to accompanying household contacts 5-6 times per day. Distribution of hygiene kits was limited and only 52% of admitted suspected cholera cases received a hygiene kit. The delay of the overall response, delayed supply and insufficient quantities of hygiene kits available limited the coverage and utility of the hygiene kits, and may have diminished the effectiveness of the intervention. The integration of a WASH intervention for cholera control at the point of patient admission is a growing trend and promising intervention for case-targeted cholera responses. However, the barriers identified in this study warrant consideration in subsequent cholera responses and further research is required to identify ways to improve implementation and delivery of this intervention.

An exploratory pilot study of the effect of modified hygiene kits on handwashing with soap among internally displaced persons in Ethiopia

“…Hygiene kits aim to reduce the risk of disease transmission by encouraging the increased practice of hygiene behaviours at the household level. However, there is limited evidence about the acceptability of hygiene kits, the use of hygiene kit products by crisis-affected populations and the effect of hygiene kit distributions on behaviour or health outcomes [ 13 , 15 , 21 – 23 ]. The available evidence is predominantly focused upon soap and hygiene kit distributions in camp settings or cholera outbreaks, and has documented mixed results [ 13 , 22 , 24 – 26 ].…”

“…One study in Bangladesh distributed hygiene kits to cholera cases upon discharge from treatment centres and showed promising impacts on behaviour and health outcomes [ 24 ]. The majority of other studies have focused on the feasibility of distributing hygiene kits, highlighting the challenges achieving sufficient coverage of the population [ 23 , 27 ]. Many of the studies of soap and hygiene kit distributions rely on self-reported measures or proxy measures of product use and behaviour [ 21 , 27 , 28 ], which are considered less reliable indicators of handwashing behaviour [ 29 ].…”

Influence of Community-Led Total Sanitation and Water Coverages in the Control of Cholera in Madarounfa, Niger (2018)

“…Based on recent studies, effective targeting interventions in hotspots could eliminate up to 50% of cases in Sub-Saharan Africa ( 11 ). Among the few studies available, D'Mello-Guyett et al ( 12 ) underline how the distribution of hygiene kits is a promising form of intervention for cholera control and that the integration of a WASH intervention at the point of admission of suspected cases is new in cholera control efforts, particularly in outbreaks and complex emergencies ( 12 ). Even though the relationship between cholera and Water, Sanitation, and Hygiene (WASH) has long been established ( 13 ), the beneficial impact of water and sanitation projects like CLTS, specifically in cholera hotspots, is often challenged due to the lack of evidence and the complexity in demonstrating such an impact (e.g., long-term implementation of WASH projects, availability of data, sustainability of WASH projects) ( 14 ).…”

An exploratory pilot study of the effect of modified hygiene kits on handwashing with soap among internally displaced persons in Ethiopia.

“…One study in Bangladesh distributed hygiene kits to cholera cases upon discharge from treatment centres and showed promising impacts on behaviour and health outcomes (24). The majority of other studies have focused on the feasibility of distributing hygiene kits, highlighting challenges with achieving su cient coverage of the population (23,27).…”

“…However, there is limited evidence about the acceptability of hygiene kits, the use of hygiene kit products by crisis-affected populations and the effect of hygiene kit distributions on behaviour or health outcomes (13,15,(21)(22)(23). Available evidence has predominantly focused on soap or hygiene kit distributions in camp settings or during cholera outbreaks and has documented mixed results (13,22,(24)(25)(26).…”